Erastus Shannon, PMH-NP
Nurse Practitioner, Psych/Mental Health in Albany, NY. Individual provider (NPI-1).
NPI number1710695762
StatusActive
Last updated in NPPESNov 8, 2022
Details
- NPI
- 1710695762
- Entity type
- Individual (NPI-1)
- Name
- Mr. Erastus Shannon
- Credential
- PMH-NP
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Nov 8, 2022
- Certification date
- Nov 8, 2022
- Last updated
- Nov 8, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | 404594 | NY | Yes |
Practice location
418 Broadway Ste NAlbany, NY 12207-2922
Phone 516-200-6865
Mailing address
418 Broadway Ste NAlbany, NY 12207-2922
Phone 516-200-6865
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